Week 8 - Lecture 3

Question 1

IgM, IgG, IgA, IgD, and IgE are all known as ___ ___.

Answer 1

gamma globulins

Question 2

___ is the first antibody formed in response to the acute phase of an infection. (1st time of activation of Herpes)

Answer 2

IgM

Question 3

___ is the second antibody formed in response to reactivation of an infection. (2nd, 3rd, 4th time of activation of Herpes).

Answer 3

IgG

Question 4

___ is known as the barrier antibody, and is found in breast milk, saliva, tears, and urine. (Helps protect against life-threatening diarrhea).

Answer 4

IgA

Question 5

___ is the antibody of allergies, responsible for anaphylaxis. It drills a hole in the ___ cells.

Answer 5

IgE, mast

Question 6

What do you need to make happy healthy RBC’s?

Answer 6

good genes

Question 7

Bad genes and hemoglobinopathies l/t ___ ___ anemia.

Answer 7

sickle cell

Question 8

Can’t determine Hgb disorder until infant is ___-___ months of age. This is when the “adult” Hgb is formed.

Answer 8

5-6

Question 9

Too much ___ can cause clotting.

Answer 9

erythropoietin

Question 10

___ causes a low metabolic rate. And decreased metabolism decreased the prod of ___.

Answer 10

Hypothyroidism, RBC’s

Question 11

Low Hgb in adult, think ___ ___. Low Hgb in peds, think ___ ___.

Answer 11

GI bld, iron defic.

Question 12

Children need iron from ___ for ___ growth.

Answer 12

food, vertical

Question 13

Pregnant pt’s need extra ___ for baby to develop properly.

Answer 13

iron

Question 14

Kids w/___ dis tend to be shorter in stature compared to other children their age.

Answer 14

celiac

Question 15

You need a healthy ___ to absorb iron. ___ dis primarily involves the duodenum.

Answer 15

duodenum, Celiac

Question 16

Pt’s w/gastric by-pass and duodenal exclusion sgy’s need to be on ___ supplement.

Answer 16

iron

Question 17

You need ___ in the stomach in order to absorb iron.

Answer 17

acid

Question 18

PPI’s (prilosec, nexium, protonix) suppress ___, which doesn’t allow for ___ absorption.

Answer 18

acid, iron

Question 19

Consider log-term ___ suppression w/PPI’s as a cause of ___ defic.

Answer 19

acid, iron

Question 20

Tests for iron excess/defic include: serum ___, total iron ___ ___, and serum ___.

Answer 20

ferritin, binding capacity, iron

Question 21

Serum ferritin in male = ___-___

female = ___-___

Answer 21

20-250

10-120

Question 22

Serum ferritin levels ___ in menopausal women.

Answer 22

increase

Question 23

Need ___ for RBC prod. Stored in the liver for 5-7 yrs.

Answer 23

B12

Question 24

Pork, eggs, dairy, fish, brewer’s yeast, and meat all have high levels of ___.

Answer 24

B12

Question 25

Vegetarians are at high risk for ___ deficiency.

Answer 25

B12

Question 26

___ is a co-factor in the prod of serotonin, and maintains CNS myelin and PNS myelin.

Answer 26

B12

Question 27

B12 deficiency is also known as ___ anemia.

Answer 27

pernicious

Question 28

Small intestines are involved in Crohn's dis, so need ___ shots.

Answer 28

B12

Question 29

___ is transported to ___ for storage, and ___ ___ for RBC prod.

Answer 29

liver, bone marrow

Question 30

Pt's w/liver failure will most likely have ___ defic.

Answer 30

B12

Question 31

High risk groups for B12 defic include: over age ___ (probs w/absorption), lack of ___ ___, ___ (no animal protein in diet), pt's in ___ ___, ___ (deplete B12 storage in liver), ___ (celiac dis, crohn's dis, gastric by-pass sgy), and meds like ___ and ___.

Answer 31

55, intrinsic factor, vegetarians, liver failure, malabsorption, Metformin, PPI's

Question 32

B12 defic is the #1 cause of ___. However, this is reversible by giving supplement. This is when B12 levels are below ___.

Answer 32

dementia, 200

Question 33

S/E of too much Vit B12 is ___ ___.

Answer 33

anal itching

Question 34

___ ___ maintains neural tube in pregnant pt's.

Answer 34

Folic acid

Question 35

Need ___ ___ for maintenance of healthy RBC's.

Answer 35

folic acid

Question 36

Foods high in ___ ___ include: green leafy's, citrus fruits, fortified cereals, and breads.

Answer 36

folic acid

Question 37

Bactrim/TMP, methotrexate, phenytoin/dilantin, and OCP's are all drugs that block ___ ___ synthesis. Need to supplement pt's on these meds.

Answer 37

folic acid

Question 38

Stem cells, erythroblasts, pronormoblasts, normoblasts, and reticulocytes all reside in ___ ___.

Answer 38

bone marrow

Question 39

Reticulocytes and erythrocytes reside in ___ ___.

Answer 39

peripheral blood

Question 40

Normal RBC count = ___-___ million.

Answer 40

4.5-6

Question 41

All "blast" cells should be in ___ ___, not in ___ ___.

Answer 41

bone marrow, periph bld

Question 42

If the cell contains a nucleus, it is a ___ cell.

Answer 42

blast

Question 43

It takes 7-12 days to make and release a ___ from the bone marrow. Therefore, need to wait this amt of time before getting a ___ count if injured.

Answer 43

reticulocyte, reticulocyte

Question 44

Spleen can regenerate before age ___.

Answer 44

12

Question 45

High retic counts means that the bone marrow is making ___, but something is destroying them rapidly.

Answer 45

RBC's

Question 46

___-___ are the population at highest risk for sickle cell anemia and is ___.

Answer 46

African-Americans, genetic

Question 47

Normal retic count = ___-___%

Answer 47

0.5-1.5%

Question 48

#1 autoimmune hemolytic anemia dis in African-American women is ___.

Answer 48

lupus

Question 49

+ Coombs test would most likely indicate ___. It means an autoimmune process w/antibodies against ___.

Answer 49

lupus, RBC's

Question 50

A low retic count is underproduction ___. Can be caused by deficiency of ___, ___, or ___ ___, and also ___.

Answer 50

anemia, B12, iron, folic acid, chemo

Question 51

Normal Hgb females = ___-___ | males = ___-___

Answer 51

11-15.5 | 13-17.3

Question 52

The ___ of the RBC also helps define anemias.

Answer 52

size

Question 53

MVC stands for ___ ___ ___. Normal MCV = ___.

Answer 53

mean cell volume, 90

Question 54

MCV of 65 is ___ anemia. MCV of 90 is ___ anemia. MCV of 120 is ___ anemia.

Answer 54

microcytic, normocytic, macrocytic

Question 55

Marathon runners, pumping too much iron, NSAIDS, and PPI's typically cause ___ defic anemia

Answer 55

iron

Question 56

Lead poisoning is cause of ___ anemia.

Answer 56

microcytic

Question 57

___ is best value to look at to help determine true anemia dx.

Answer 57

MCV

Question 58

___ (aka SGOT) is ___-___ and is found in many tissues.

Answer 58

AST, non-specific

Question 59

___ (aka SGPT) is found almost exclusively in liver cells and is highly specific for the ___.

Answer 59

ALT, liver

Question 60

If ALT elevated, question ___ exposure, too much ___, and drug effects such as ___.

Answer 60

hepatitis, alcohol, tylenol

Question 61

Normal AST = ___-___ | Normal ALT = ___-___

Answer 61

8-20 | 10-40

Question 62

Normal AST/ALT ratio ~ ___. If > 1, consider ___. ___ is especially sensitive to alcohol.

Answer 62

1, alcohol, AST

Question 63

If alcohol dmges liver cells, the ___ will increase higher than the ___.

Answer 63

AST, ALT

Question 64

Will see elevated ___ in liver enzymes w/hypothyroidism.

Answer 64

TSH

Question 65

3 most common causes of unexplained ALT elevations include: chronic ___ ___, ___ liver dis, and ___ ___ liver dis.

Answer 65

hepatitis C, alcoholic, nonalcoholic fatty

Question 66

Pt's who received bld trans before July 1992 at higher risk for ___ ___

Answer 66

Hepatitis C

Question 67

Nonalcoholic steatohepatitis (NASH) is defined as steatosis + significant liver ___, characterized by presence of ___ infiltrates l/t ___, ___, and ___.

Answer 67

inflam, inflam, fibrosis, cirrhosis

Question 68

Obesity, diabetes, males more than females, drugs (prednisone, methotrexate, amiodarone, tamoxifen, nifedipine, diltiazem) are all causes of ___-___ ___ liver dis.

Answer 68

non-alcoholic fatty

Question 69

Other causes of elevated liver enzymes include: cleaning ___, Vit ___ toxicity (by eating too much liver), ___, and ___ products (yerba tea, skull cap, mistletoe)

Answer 69

chemicals, A, alcohol, herbal

Question 70

Meds that can cause drug-induced liver injury include: ___ (not to exceed 4gm), ___ steroids (used by athletes), ___ (risovastatin), ___ (motrin), ___ (tx for a-fib), ___ (mood stabilizer), ___ (anti-seizure), ___, and ___.

Answer 70

acetaminophen, anabolic, statins, NSAIDS, amiodarone, rheumatrex, depakote, ING, Imuran

Question 71

Viral causes of elevated liver enzymes include: ___ ___, caused by ___-___ transmission (salad bar/buffet)

Answer 71

Hepatitis A, fecal-oral

Question 72

Hepatitis B risk factors include: ___ transmitted, transmitted via ___ in NB, ___ drug use, and ___ ___ before July 1992.

Answer 72

sexually, placenta, IV, bld trans

Question 73

Hepatitis C risk factors include: ___ drug users, ___ ___ injury, ___ ___ before July 1992, pt's who have ever received ___, children born to ___-infected moms.

Answer 73

IV, needle stick, bld trans, hemodialysis, HCV

Question 74

Secondary risk factors for Hepatitis C include: sexual transmission w/___ partners, ___ ___ use, ___, and ___.

Answer 74

multiple, intranasal cocaine, tattoos, piercings

Question 75

Any disturbance in the synthesis, secretion, or excretion of bile l/t the accumulation of ___ ___ in the liver. This in turn increases the synthesis of ___ ___.

Answer 75

bile acids, alkaline phosphatase (ALP)

Question 76

ALP is a sensitive indicator of ___.

Answer 76

cholestasis

Question 77

___ is bound to bone, so will be ___ during growth spurts in kids. Will also see elevated in ___ dis, ___, and metastatic dis to ___.

Answer 77

ALP, increased, Paget's, osteosarcoma, bone

Question 78

W/pancreatitis, you will see a fast and high rise of ___ w/in 12 hrs.

Answer 78

amylase

Question 79

2 major causes of pancreatitis are:

Answer 79

alcohol, gallstones

Question 80

Creatine kinase (CK) is stored in ___-energy tissues. Is found in ___ muscle, ___ muscle, and the ___.

Answer 80

high, skeletal, cardiac, brain

Question 81

``` CK-MB = ___ muscle CK-MM = ___ muscle CK-BB = ___ ```

Answer 81

skeletal cardiac brain

Question 82

When on statins and c/o muscle aches/pains, draw a ___ to r/o ___.

Answer 82

CK-MB, rhabdo

Question 83

LDH___ is most common elevation usually d/t ___ muscle dmg (banged knee or bumped into something)

Answer 83

5, skeletal

Question 84

Draw a ___ ___ if pt c/o CP or having MI.

Answer 84

troponin T

Question 85

___ ___ is a structural protein, not a serum enzyme.

Answer 85

Troponin T

Question 86

___ ___ is elevated in ___ necrosis and is more specific than ___ b/c remains elevated for 3-14 days.

Answer 86

Troponin T, cardiac, CK-MB

Question 87

___ ___ rises in 3-12 hrs, peaks at 24, down in 3-14 days.

Answer 87

Troponin T

Question 88

If Troponin T not elevated 6-9 hrs after CP onset, ___ ___ ___ not likely.

Answer 88

acute coronary syndrome